NEW ROCHELLE, N.Y. - An outbreak of rubella in New York has resulted in at least 22 confirmed cases of disease and dozens more suspected cases, according to the Westchester County Health Department.
Since Dec. 19, 1997, 22 confirmed cases of rubella, in addition to 30-40 suspect cases, have been reported in Westchester County. Neighboring cities in Connecticut have also reported cases, all of which have been focused in adults from Central and South American countries where measles-mumps-rubella (MMR) vaccination seldom occurs. Clusters of immigrants from these countries have settled in these areas of New York and Connecticut in recent years.
Mary Landrigan, spokeswoman for the Westchester County Health Department, said the large number of suspect cases are because all reports have not been completely evaluated.
So far the investigation has revealed that the cases have spread entirely across the geographically large county, although most cases have been reported from the Port Chester area, adjacent to Connecticut. However, some cases have been reported on the opposite side of the county, near the Hudson River.
"So, we feel it's not a point area and is more widespread than that," she said.
Several cases have been reported outside that community because the disease spreads easily to anyone who is not immune. Luckily, Landrigan said, up to 90% of Westchester County residents are immune to rubella through either immunization or natural infection.
The majority of reported cases have been primarily among Latino men in their 20s and 30s, a group that represents a large proportion of the new residents in Westchester County. Investigators have some suspicions as to why this population is disproportionately effected, but haven't been able to identify the exact reason.
The suspicions are based on the fact that some Central and South American countries do not have well-structured immunization programs. Therefore, new immigrants are often unimmunized and the majority of these immigrants are men in their 20s, Landrigan said.
"I think this is not common only to Latin America, there are some European countries that also have different ways for immunizing people against rubella," she said.
Twenty rubella cases have also been reported in Connecticut, according to Vincent Sacco, coordinator for the Connecticut State Immunization Program. Fourteen cases are confirmed and six are still suspect cases. Of the 20 reported cases, 14 are men, 18 are of Latino background, and all cases are between 18 and 42 years old, which is consistent with the New York cases.
Most of the cases are Fairfield County, specifically in Stamford, but others have been identified in Norwalk and Greenwich. These communities have a growing Latino population, according to Sacco.
Although there have been no reported cases of congenital rubella syndrome, a young Honduran women had a confirmed rubella infection in her first trimester and subsequently miscarried. However, Sacco said tests have not confirmed the miscarriage was due to rubella.
A confirmed case of rubella in a pregnant female has been reported in New York, but Landrigan said she was past the first trimester when diagnosed and the danger of congenital rubella syndrome decreases after the first trimester.
Children were not affected by this outbreak, Landrigan said, because they are required to have all routine immunizations before entering the school system. Also, few women were infected in this outbreak, which investigators suspect is because they are often more exposed than men to the health care system and have more opportunities to be vaccinated.
"Pediatricians are doing a wonderful job at making sure those 0- to 2-year-olds are immunized. We strongly encourage pediatricians to use the opportunity to immunize someone bringing in that 2-year-old who needs an immunization," she said. "In this case, our children seem to be well immunized, but it's their parents who have somehow slipped through the cracks in some cases, so this would be an opportunity to provide an immunization."
The Centers for Disease Control and Prevention (CDC) has been tracking rubella outbreaks over the past two years and this finding is similar to the CDC profile for cases. There are usually one or two outbreaks of rubella a year in the United States, according to the CDC.
Susan Reef, MD, medical epidemiologist, National Immunization Program, CDC, said vaccination with measles-mumps-rubella (MMR) is the only way to stop the spread of cases.
To combat this outbreak, the health department in New York is offering free immunizations at four health offices spread throughout the county. Four health centers in different areas of the county are also offering free shots with MMR, and the hospitals and various large pediatric practices are helping with surveillance.
"One of the hospitals is actually providing immunizations from its emergency room from 11 a.m. to 11 p.m. every day," said Landrigan. "We have a lot of people who are attempting to help us with our immunization campaign," she said.
"We also conducted several church basement immunization clinics, and we're providing free vaccine to clinicians who see large numbers of people," she added.
Free employment setting vaccinations are also being conducted in Greenwich. However, at press time, only 35 doses of vaccine have been administered.
Sacco said it has been difficult to track cases in affected communities. Reaching the population at risk is also difficult, he added, because immigrants are typically hesitant to divulge any unnecessary information for fear of deportation. However, approximately 220 doses of vaccine have been given.
Health officials are also working with the Women, Infants and Children (WIC) program to reach more people. Sacco said one of the local hospitals has been immunizing patients in their adult primary care clinic and pediatric outpatient clinic.
A letter to obstetrician and gynecologic practices was also sent in January to advise them of the outbreak and encourage them to make sure their patients are protected.
In a similar outbreak of rubella in North Carolina in 1997, Landrigan said approximately 100,000 people were immunized. The Westchester County cases are fast approaching the number of cases seen in North Carolina.
"We feel like we are embarking on a slow and laborious process to immunize a very large number of people," Landrigan said. "We expect it's going to take a while to bring rubella under control."
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